Fluid And Electrolyte Imbalance

Question 1

What are the different ranges of electrolyte

Answer 1

Calcium 2.2-2.6

Magnesium 0.6- 1.0

Phosphate 0.87- 1.45

Potassium 3.5-5.3

Sodium 133- 146

Question 2

What are the different electrolyte imbalances

Answer 2

HYPOkalemia- muscle cramps, rhabdomyolysis, fatigue, palpitations arrhythmias

HYPERkalemia- fatigue, numbness, nausea, SOB, chest pain, palpitations

HYPOnatraemia- nausea, headache, confusion, fatigue, irritability, seizures

HYPERnatraemia- thirst, fatigue, confusion

HYPOcalcaemia- muscle cramps, confusion, depression, forgetfulness

HYPERcalaemia- nausea, lethargy, muscle cramps, confusion and arrhythmias

Question 3

What drugs causes hypokalemia

Answer 3

Aminophylline/ theophylline
Beta agonists
Corticosteroids
Diuretics (loops and thiazide )
Erythromycin/ clarithromycin
Insulin

ABCDE I

Question 4

What drugs causes hyperkalemia

Answer 4

Trimethoprim
Heparin
ACE/ARBS
NASIDS
K-Sparing Diuretics
Beta Blockers

THANKS B

Question 5

What does potassium imbalances lead to

Answer 5

Imbalances leads to arrhythmias and cardiac side effects

Hypokalemia predisposes patients taking digoxin to toxicity

Question 6

How do you treat hypokalemia

Answer 6

Mild-moderate hypokalaemia
Oral replacement therapy- Sandro-k tablets

Severe hypo
- IV KCL in NaCL

Potassium replaced cautiously in patient who have renal impairment
-risk of hyperkalaemia secondary to impaired potassium excretion

Question 7

How do you treat hyperkalaemia

Answer 7

Acute severe hyperkalaemia (plasma conc >6.5mmol/l)
-urgent treatment
-IV calcium chloride 10%/ calcium gluconate 10%
- IV soluble insulin 5-10 units with 50ml glucose given over 5-15 minutes
-salbutamol (nebulisation or slow IV injection)
Drugs exacerbating hyperkalaemia should be reviewed and stopped as appropriate

Mild-moderate hyper
Ion exchange resins may be used to remove excess potassium (calcium reasonium )

Question 8

What drugs causes hyponatraemia (sodium)

Answer 8

Carbamazepine
Diuretics
Desmopressin/vasopressin
SSRIs

Certain Drugs Ditch Salt

Question 9

What drugs cause HYPERnatraemia

Answer 9

Sodium bicarbonate/chloride
Corticosteroids
Effervescence formulations
Oestrogens/ androgens

Salty CEO

Question 10

How do you treat hyponatraemia

Answer 10

Mild- moderate: oral supplement (sodium chloride or sodium bicarbonate)

Severe- IV NaCL

Question 11

What do you do if you have HYPERnatraemia

Answer 11

Reduce sodium intake through your diet

Question 12

Calcium

Answer 12

Calcium supple to may be needed if dietary calcium intake is deficient

Osteoporosis: double recommended amount reduces rate of bone loss

Oral supplements of calcium given with vitamin d (calichew, adcal )

In severe acute hypercalaemia or hypokalaemia
- Initial slow IV calcium gluconate 10% with plasma-calcium and ECG monitoring (arrhythmias if given rapidly)

• repeated if needed or follow with continuous IV infusion to prevent reoccurrence

Question 13

What is the treatment for hypercalaemia

Answer 13

Severe
Correct dehydration first with NaCL 0.9%
Discontinue drugs which cause hypercalaemia, restrict dietary calcium (thiazide duiretics, lithium vitamin d intake= hypercalaemia)
Biphosphonates and pamidronate disodium used
Corticosteroids used if hypercalaemia is due to sarcoidosis or vitamin d toxicity
Calcitonin used in hypercalaemia associated with malignancy

Hypercalciuria
Increasing fluids and bendroflumethiazide
Reduced dietary calcium intake but not severe restriction (harmful)

Question 14

Drugs that cause hypocalaemia

Answer 14

Rifampicin
Phenytoin
Phenobarbital

Question 15

Drugs that cause hypocalaemia

Answer 15

Rifampicin
Phenytoin
Phenobarbital
Alendronic acid

Question 16

What is meant by hyperparathyroidism

Answer 16

Excess parathyroid hormone- hypercalaemia, hypercalciuria and hypophosphataemia
Comes with thirst, polyuria, constipation, fatigue, memory impairment, CVD, kidney stones and osteoporosis

Affects as twice as many women than men- common in women 50-60

Parathyroidectomy surgery is recommended first line treatment in primary hyperparathyroidism
Assess CVD risk and fracture risk

Drug treatment
Cinacalcet if surgery has been unsuccessful/ declined
In secondary care, measure vit d levels, supple to if needed
To reduce fracture risk: bisphosphonates

Question 17

Magnesium

Answer 17

Essential in enzyme systems, energy generation- stored in the skeleton
Excreted in the kidneys therefore retained in renal failure- hypermagnesaemia

Hypermagnesaemia
Causes muscle weakness and arrhythmias
Calcium gluconate injection is used for the management of magnesium toxicity

Hypomagnesaemia
Symptomatic : IV/IM magnesium sulfate (IM=painful)

Mild- oral magnesium

Question 18

Phosphate

Answer 18

Hypophosphataemia
In patience with alcohol dependence or severe DKA
Oral phosphate supplement

Hyperphosphataemia
Phosphate binding agents (calcium based or non calcium based preparations)

Patients with stage 4/5 CKD: manage diet + dialysis before starting agents
1st line: calcium acetate
2nd line sevelamer
3rd line CAco3 Calcium based or sucroferric oxyhydroxide (non calcium based)